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Objective Methods Results Conclusion To study the impact of respectful maternity care (RMC) training of health care providers on RMC and birth satisfaction in mothers undergoing normal vaginal birth.A prospective interventional study was performed comparing RMC and birth satisfaction in women undergoing vaginal births before and after RMC training of health care providers from November 2021 to March 2023 in a tertiary care center in India. Person‐centered maternity care (PCMC) and birth satisfaction scale‐revised (BSSR) scales were used to study women's RMC and birth satisfaction, respectively.A total of 100 women undergoing normal vaginal birth were enrolled in pre‐ and post‐intervention phases. The intervention was done through formal and onsite training of health care providers in RMC. The mean total PCMC scale score in the post‐training group demonstrated a remarkable increase to 51.95 ± 6.50, significantly higher than the pre‐training mean of 32.82 ± 8.47 (P < 0.0001). The mean ± SD of the BSSR scale total score in the post‐training group increased significantly to 27.17 ± 3.67, surpassing the pre‐training mean of 21.19 ± 5.48 (P < 0.0001).The study showed significant improvement in RMC and birth satisfaction score in the post‐training group thereby emphasizing the importance of RMC training of health care providers in the facility. [ABSTRACT FROM AUTHOR]

Background: Health care providers (HCPs) caring for autistic children report more perceived psychological and emotional distress related to their job. However, not much is known about what can be done to mitigate such distress, especially in countries with limited mental health resources, such as Jordan. Objective: This study aimed to examine the association between coping strategies (problem-focused, emotion-focused, and avoidant) and perceived emotional and psychological distress among HCPs of autistic children in Jordan. Methods: In this cross-sectional study, a convenience sample of 180 HCPs working with autistic children in Jordan were recruited through autism centers and social media using an online self-administered questionnaire. Results: The multiple linear regression analysis revealed that 31% of the variability in perceived emotional distress was explained by its significant association with problem-focused coping, emotion-focused coping, and avoidant coping. Likewise, 39% of the variability in perceived psychological distress was explained by its significant association with gender, having an immediate family, area of specialty, problem-focused coping, emotion-focused coping, and avoidant coping. Conclusions: The study shows that problem-focused coping significantly decreases perceived emotional distress, whereas emotion-focused and avoidant coping significantly increase perceived emotional distress. Avoidant coping significantly increases perceived psychological distress. Understanding the association between coping strategies and perceived emotional and psychological distress among HCPs can assist mental health nurses in identifying at-risk providers and providing timely emotional and psychological support. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, the way in which end-of-life care was provided, underwent a lot of changes and therefor different domains of end-of-life care were impacted. The aim of this study is to describe whether health care providers considered end-of-life care (in medical, nursing, psychosocial and spiritual care) limited by the pandemic through the first 18 months of the COVID-19 pandemic, and examine associations with COVID-19 related circumstances of care (e.g. visit restrictions) and health care providers' characteristics. Methods: A longitudinal survey study among healthcare providers from different healthcare settings who provided end-of-life care during the pandemic's first 18 months. Data of four time periods were analyzed using descriptive statistics and Generalized Estimating Equation. Results: Of the respondents (n = 302) the majority had a nursing background (71.8%) and most worked in a hospital (30.3%). Especially in the first wave end-of-life care in all aspects was limited according to a substantial part of health care providers (between 29.7 and 57.7%). Psychosocial and spiritual care were more limited than medical and nursing care during all time periods. Care being limited according to health care providers was associated with visit restrictions, shortness of personal protective equipment or restrictions in caring for the deceased and decreased over time. Conclusion: The COVID-19 pandemic impacted different aspects of end-of-life care throughout the pandemic's first 18 months. Over the course of the pandemic health care providers seemed to have invented ways to adjust their work in order to minimize the effect of limiting measures. More involvement of health care providers in decision-making may improve the prioritization of measures to deal with crisis situations in care. These reflections highlight priorities during crises and the role healthcare providers could play in maintaining good end-of-life care. This remains relevant in new health crises, where care may differ from what is considered good quality of care. [ABSTRACT FROM AUTHOR]

Background: Access and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers' perceptions and experiences of providing contraception services to AGYW. Methods: Data were collected through semi-structured individual interviews with AGYW aged 15–24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa's Western Cape Province. Thematic analysis was used to analyse the data. Results: AGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW's access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers' hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW's access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers' work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW. Conclusion: The expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider's hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW's access to and use of contraception services, and subsequently achieve the country's SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers. [ABSTRACT FROM AUTHOR]

BackgroundThe efficacy of providing self-acupressure educational materials in reducing stress and improving health-related quality of life (HRQOL) is uncertain. Evidence-based data to recommend for or against self-acupressure as an intervention for reducing stress and improving HRQOL is needed.ObjectiveThe Self-Acupressure for Stress (SAS) trial evaluates whether providing self-acupressure educational materials would reduce stress and improve HRQOL among health care providers (HCPs).DesignRandomized behavioral clinical trial.SettingThe entire study took place remotely.ParticipantsOne hundred fifty-nine adult HCPs with no prior experience or training in acupressure.InterventionThe intervention group received self-acupressure educational materials.MeasurementsPrimary outcomes were perception of stress measured by the Perceived Stress Scale (PSS), as well as scores on the physical and mental components of the 12-item Short Form Health Survey version 2 (SF-12v2).ResultsFrom the baseline to midpoint evaluations, the intervention group significantly reduced their PSS score (P ≤ .001) and increased their SF-12v2 Mental score (P = .002) but not their SF-12v2 Physical score (P = .55). These findings persisted at the final follow-up (both PSS and SF-12v2 Mental changes from baseline P < .001). However the control group also significantly improved their SF-12v2 Mental from baseline to midpoint (P = .01) which was maintained at final follow-up (P = .02), whereas PSS and SF-12v2 Physical did not significantly change from baseline at either mid or final. Finally, the intervention group improved by significantly more than the control group from baseline to final follow-up for both PSS (P = .007) and SF-12v2 Mental (P = .02) HRQOL measures.LimitationThe trial was not blinded.ConclusionAmong HCPs during the coronavirus disease 2019 (COVID-19) pandemic, the provision of self-acupressure educational materials safely improved self-reported assessments of perception of stress and mental health. Self-acupressure represents a promising intervention for other populations. The study findings support the use of self-acupressure to reduce stress and improve HRQOL.Trial registrationClinicalTrials.gov: NCT04472559.

The systematic review was to assess the mental health status of healthcare workers due to the COVID-19 Pandemic. For this systematic review, 25 articles were selected manually from 2021 and 2022. The selected articles focused on the effects of COVID-19 on health workers like burnout, insomnia depression, anxiety, and traumatic stress. Original peer-reviewed observational and descriptive studies were identified using PubMed, and Google Scholar engine. Articles revealed a high significance between health care professionals’ post-traumatic stress disorder, sleeplessness, burnout, and depression, whereas few studies mainly indicated the positive correlation between burnout and stress among HCWs, with insomnia highly significant. The systematic review concluded that among healthcare personnel, an elevated risk of developing psychological distress, burnout, sleep quality, and insomnia during the COVID-19 pandemic exists. Our review underlines the requirement for intervention and further longitudinal study designs directed at prevention, treatment, and effective ways to delineate the causation of mental health outcomes in healthcare workers

Abstract Background During the COVID-19 pandemic, the way in which end-of-life care was provided, underwent a lot of changes and therefor different domains of end-of-life care were impacted. The aim of this study is to describe whether health care providers considered end-of-life care (in medical, nursing, psychosocial and spiritual care) limited by the pandemic through the first 18 months of the COVID-19 pandemic, and examine associations with COVID-19 related circumstances of care (e.g. visit restrictions) and health care providers’ characteristics. Methods A longitudinal survey study among healthcare providers from different healthcare settings who provided end-of-life care during the pandemic’s first 18 months. Data of four time periods were analyzed using descriptive statistics and Generalized Estimating Equation. Results Of the respondents (n = 302) the majority had a nursing background (71.8%) and most worked in a hospital (30.3%). Especially in the first wave end-of-life care in all aspects was limited according to a substantial part of health care providers (between 29.7 and 57.7%). Psychosocial and spiritual care were more limited than medical and nursing care during all time periods. Care being limited according to health care providers was associated with visit restrictions, shortness of personal protective equipment or restrictions in caring for the deceased and decreased over time. Conclusion The COVID-19 pandemic impacted different aspects of end-of-life care throughout the pandemic’s first 18 months. Over the course of the pandemic health care providers seemed to have invented ways to adjust their work in order to minimize the effect of limiting measures. More involvement of health care providers in decision-making may improve the prioritization of measures to deal with crisis situations in care. These reflections highlight priorities during crises and the role healthcare providers could play in maintaining good end-of-life care. This remains relevant in new health crises, where care may differ from what is considered good quality of care.

Abstract Background Access and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers’ perceptions and experiences of providing contraception services to AGYW. Methods Data were collected through semi-structured individual interviews with AGYW aged 15–24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa’s Western Cape Province. Thematic analysis was used to analyse the data. Results AGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW’s access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers’ hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW’s access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers’ work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW. Conclusion The expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider’s hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW’s access to and use of contraception services, and subsequently achieve the country’s SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers.

Ahmed M Al-Wathinani,1 Yahia O Dhafar,2 Salah A Aljarallah,3 Muqbil Saad Alqahtani,4 Fahad Abdullah Alamri,5 Awad O Aljohani,6 Majed D Alanazi,7 Turky J Arbaein,8 Amal M Zaidan,9 Mohammed Aljuaid,10 Krzysztof Goniewicz11 1Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, 11541, Saudi Arabia; 2SEHA Virtual Hospital, Ministry of Health, Riyadh, 1154, Saudi Arabia; 3Department of Family Medicine, King Khaled University Hospital, King Saud University, Riyadh, Saudi Arabia; 4Department of Dentistry, College of Dentistry, King Faisal University, Alhafouf, 36932, Saudi Arabia; 5Ambulatory Care Administration, Ministry of Health, Riyadh, 11525, Saudi Arabia; 6Fresenius Kabi Scientific Office Alsaif Building, Riyadh, 1141, Saudi Arabia; 7Department of Family Medicine, General Directorate of Health Affairs in Riyadh Region, Ministry of Health, Riyadh, 12822, Saudi Arabia; 8Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia; 9College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Research Center’s (KAIMRC), Riyadh, Saudi Arabia; 10Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia; 11Department of Security, Polish Air Force University, Deblin, PolandCorrespondence: Ahmed M Al-Wathinani, Email ahmalotaibi@ksu.edu.saIntroduction: This cross-sectional descriptive study evaluates the experiences and perceptions of healthcare providers (HCPs) regarding the 937 medical call center in Saudi Arabia, a key telemedicine initiative.Aim: To assess HCP satisfaction, identify challenges, and provide recommendations for improvement.Methods: Conducted from November 20th to December 15th, 2022, the study surveyed 454 HCPs, achieving a 90.5% response rate.Results: A majority (86.8%) of respondents were satisfied with the call center, valuing its ease of use and effectiveness in healthcare delivery. However, challenges such as the accuracy of remote medical assessments, the need for clearer telehealth regulations, and concerns over management support and consultation overlaps were identified. The study also highlights the importance of ongoing support and updates, comprehensive telehealth regulations, integration of more medical specialties, and improvements in system integration and data confidentiality.Conclusion: The study underscores the need for strategic enhancements to the 937 call center to further improve healthcare accessibility and efficiency in Saudi Arabia. These enhancements are vital for aligning telehealth services with Saudi Arabia’s healthcare objectives under Saudi Vision 2030.Keywords: telemedicine, Saudi Arabia, health care providers, patient satisfaction, health services accessibility, telehealth, medical informatics, health policy

Abstract Background In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. Methods We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers’ views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants’ recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. Results Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. Conclusions Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.

Medical professionals face high stress due to the type of work they do and the prolonged working hours. Frequent burnout results due to the challenging nature of their work. Added to the stress of work, malpractice lawsuits add to their burden. In India, most doctors work in compromised settings with poor infrastructure and manpower but are expected to follow the best practices. In court, they are judged with the Bolam and Bolitho tests being essential considerations. Several tragic incidents have been reported, including depression, anger issues, and even suicide deaths of healthcare professionals (HCPs) after accusations of negligence and subsequent inquiry. Such incidents demonstrate the multitude of challenges an HCP faces in day-to-day practice. It is crucial to find ways to tackle these problems and enhance the capacity of HCP to handle such demanding circumstances. Malpractice litigation can significantly impact the mental health of HCPs. It is common to experience emotional turmoil when faced with a lawsuit. Second victim syndrome (SVS) is a term used to describe a set of symptoms experienced by HCPs who make an error leading to injury to a patient. However, it also happens if he is traumatized by the consequences of violence during healthcare services or a lawsuit or defamation article in newspaper/social media. Following a litigation crisis in their career, many HCPs go through various stages of grief, including shock, denial, anger, bargaining, depression, and acceptance. At times, death by suicide of the HCPs is well known. SVS is known to profoundly affect the personal, family, economic, professional (defensive practice), and social life of HCPs. HCPs should accept the allegations of negligence as an occupational hazard and prepare for the eventual litigation at least once in a lifetime by knowing about the medical laws, HCP’s rights, becoming aware of the emotional turmoil of the lawsuit, preparing to cope with the lawsuit, and seeking help from colleagues and indemnity insurance. Frequent training of the HCPs is strongly recommended to know about the changing laws and also to undergo periodic professional competence enhancement to reduce the incidents of errors amounting to medical negligence. Medical and hospital administration should debrief after any incident and conduct internal investigations to identify systemic flaws and prevent future recurrence, resolve issues within their control at their level, and manage media (mainstream and social media) appropriately. If established, a reporting system with online and offline services will ease the internal administrative investigation process and take appropriate, timely actions. During the crisis, HCPs should have adequate and appropriate insurance or indemnity coverage and mental health support systems.

Context: As per the national policy, two doses of COVID-19 vaccine at least four weeks apart were available for administration to all HCW’s since January 2021. A small proportion of individuals will contract COVID-19 despite complete vaccination. Healthcare workers (Health Care Providers) represent a very high-risk group for contracting COVID-19 infection. Aim: To determine the breakthrough infection rate of COVID-19 among vaccinated healthcare providers and students. Methodology: The present cross-sectional study was conducted at All India Institute of Medical Sciences, Nagpur from August to December 2022. The sample size of 308 was achieved through proportionate stratified sampling among different cadres of employees working at the institute. Statistical Analysis: Chi-square test was used for significance. Fischer’s Exact test was used wherever necessary. A P value < 0.05 was considered statistically significant. Strength of the association was estimated using odds ratio. Results: The mean (SD) age of participants in our study was 29.26 (±8.64) years. Prevalence of COVID breakthrough infection was found to be 28.25% [95% CI: 23–33]. It was found that those participants having one or more co-morbidities and are directly involved in COVID patient care were likely to suffer more from COVID-19 breakthrough infection. Conclusion: Predictors of COVID-19 breakthrough infection found to be a presence of one or more co-morbidities, direct involvement with COVID-19 patients and not observing respiratory hygiene. There is increased risk among participants with comorbidities and involving directly in patient care. Therefore, it is recommended that vaccine policy needs to focus on high-risk group.

Abstract Background In Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning. Method The study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis. Results The results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p

Abstract Background Violence against women (VAW) is a significant public health problem. With the emergence of the COVID-19 pandemic, the frequency and severity of VAW has escalated globally. Approximately one in four women in Nepal have been exposed to either physical, psychological, and/or sexual violence in their lifetime, with husbands or male partners being the perpetrators in most cases. VAW prevention has been under-researched in low- and middle-income countries, including Nepal. This study aims to explore the perspectives of local stakeholders, including healthcare providers and survivors of violence in Madhesh Province. The overarching goal is to provide insights for designing prevention and support programs that are acceptable to communities and cater to the needs of survivors. Methods An explorative qualitative study was conducted in Madhesh Province, southern Nepal. A total of 21 interviews, including 15 in-depth interviews (IDIs) with health care providers, three IDIs with women seeking general or maternal and child health services at health care centres, three key informant interviews with the local stakeholders working in the field of VAW, and one focus group discussion with violence survivors, were conducted in Nepali by trained field interviewers. Interviews were recorded, transcribed, translated into English, and analysed using content analysis. Results VAW, particularly physical violence, was a common experience in the study area. Sociocultural traditions such as dowry, child marriages and son preference were identifiable triggers for VAW, causing significant physical injuries and mental health problems, including suicide. Health care providers reported that violence survivors often hide their experiences of violence and do not seek any kind of help. Women feared that violence would increase in frequency and intensity if their perpetrators found out that they had disclosed their experiences of violence to health care providers. Local stakeholders emphasized the importance of engaging community leaders and garnering support from both women and men in interventions designed to reduce VAW and its impacts on mental health. Conclusions Participants reported that verbal and physical violence is often perceived as a normal part of women’s lives. Women should be made aware of available support services and empowered and supported to increase access and uptake of these services. Additionally, more individual-based counselling sessions that encourage women to escape violence and its mental health consequences while maintaining privacy and confidentiality are recommended.

Abstract Background Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives’ perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. Methods We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). Results Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives’ preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. Conclusion Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth’ perceptions of digital health care services for sexual and reproductive health.

Background: In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. Methods: We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. Results: Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. Conclusions: Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer. [ABSTRACT FROM AUTHOR]

Introduction Burnout has been widely studied among oncology health care providers such as nurses and doctors. However, it is a less explored but highly prevalent factor in family caregivers of patients with cancer. Objective The study aimed to understand the construct of burnout among health care providers and family caregivers of patients with cancer, through three objectives: (1) to distinguish burnout between health care providers and family caregivers; (2) to predict burnout based on measurable characteristics, namely, perceived stress, psychological morbidity, well-being, problem-focused coping, emotion-focused coping, and avoidant coping; and (3) to find out the levels of burnout (low, medium, and high) in health care providers and family caregivers. Materials and Methods It is a cross-sectional study conducted among the health care providers and family caregivers of patients with cancer. The measures used in the study were the Professional Quality of Life scale, 12-Item General Health Questionnaire, Perceived Stress Scale, 5-Item World Health Organization Well-Being Index, Brief COPE inventory, and a sociodemographic details form. Results The study found a statistically significant difference in the mean burnout of health care providers (p = 0.027) and family caregivers. Study variables such as perceived stress and avoidant coping positively predicted burnout, whereas well-being and emotion-focused coping negatively predicted burnout. The study also found that a majority of the participants fell into the category of "medium" level of burnout. Conclusion While enhancing well-being and employing adaptive coping styles can act as the mitigating factors to burnout, the existence of stress and maladaptive styles of coping can prove counterproductive in dealing with burnout in work environments. This indicates that there is a need for psychosocial interventions to help the medical professionals deal with the burnout. [ABSTRACT FROM AUTHOR]

Purpose - To assess the proportion of Health Care Providers (HCPs) in Sokoto practicing Kangaroo Mother Care (KMC) in their various health facilities and identify barriers to KMC practice among HCPs in Sokoto. The purpose of this research is to evaluate the extent of KMC adoption and uncover the obstacles that hinder its effective implementation. Design/methods/approach - A cross-sectional descriptive study was conducted among 80 Health Care Providers (HCPs) who attended the World Prematurity Day celebration in 2022. The program was held at the Medical and Health Workers Union office, Tamaje, Sokoto, on December 2, 2022. A structured questionnaire comprising both open and close-ended questions was used. Data obtained were analyzed using SPSS version 25. Findings - The mean age of the HCPs was 32.9±7.6 years, with the majority, 30 (37.5%), having less than five years of working experience. Of the 80 respondents, 41 (51.3%) were nurses, 9 (11.2%) were doctors, and 16 (20.0%) were midwives. Forty-three (53.7%) of the HCPs practiced KMC. The most common barriers to implementing KMC among the HCPs were lack of privacy for the mothers (23, 28.8%), lack of space for the mothers (21, 26.3%), cultural reasons (19, 23.8%), and lack of skills on KMC (16, 20.0%). The factors associated with the practice of KMC were previous training on KMC and working in tertiary hospitals (p<0.05). Research implications/limitations - This research implies that to mitigate barriers to KMC practice in hospitals, HCPs need to be trained to acquire skills for KMC, and rooms for KMC that ensure privacy for mothers should be available in health facilities. Practical implications -By identifying and addressing the barriers to KMC, such as lack of privacy, space, and skills, health facilities can improve the adoption and effectiveness of KMC practices. Originality/value - Kangaroo Mother Care reduces morbidity and mortality in Low Birth Weight (LBW) infants, making it crucial for countries with scarce resources to adopt this practice. Healthcare providers play a vital role in educating, supporting, and assisting mothers to practice KMC in the hospital and continue it at home after discharge. [ABSTRACT FROM AUTHOR]

BACKGROUND: The reform of hospital payment systems is a top priority for policymakers in many countries, including Iran. As knowledge of the current situation and experience with previous reforms are gained, the next phase will focus on improvement. Therefore, this study aims to identify the challenges to hospital payments in the Iranian health system. METHODS: This qualitative study used semi-structured interviews and focus group discussion meetings to collect data from 29 informants, including physicians, hospital administrators, faculty members, supervisors, and executive managers with expertise in hospital payment systems. Purposive sampling was used to recruit participants. Data were analyzed using content analysis. RESULTS: The content analysis resulted in five themes and twenty-two sub-themes. Policy and regulation issues, payment methods, fair payment to providers, infrastructure and systems, and behavior of providers were cited as major challenges and drawbacks of Iran's hospital payment systems. CONCLUSIONS: Understanding the barriers to hospital payments is essential for reforming or alleviating the problem. This research has shed light on the current state of the hospital payment system in the Iranian health system. Knowledge of the issues with the current system and the needs of healthcare providers is essential for effective reform. [ABSTRACT FROM AUTHOR]

Background: Violence against women (VAW) is a significant public health problem. With the emergence of the COVID-19 pandemic, the frequency and severity of VAW has escalated globally. Approximately one in four women in Nepal have been exposed to either physical, psychological, and/or sexual violence in their lifetime, with husbands or male partners being the perpetrators in most cases. VAW prevention has been under-researched in low- and middle-income countries, including Nepal. This study aims to explore the perspectives of local stakeholders, including healthcare providers and survivors of violence in Madhesh Province. The overarching goal is to provide insights for designing prevention and support programs that are acceptable to communities and cater to the needs of survivors. Methods: An explorative qualitative study was conducted in Madhesh Province, southern Nepal. A total of 21 interviews, including 15 in-depth interviews (IDIs) with health care providers, three IDIs with women seeking general or maternal and child health services at health care centres, three key informant interviews with the local stakeholders working in the field of VAW, and one focus group discussion with violence survivors, were conducted in Nepali by trained field interviewers. Interviews were recorded, transcribed, translated into English, and analysed using content analysis. Results: VAW, particularly physical violence, was a common experience in the study area. Sociocultural traditions such as dowry, child marriages and son preference were identifiable triggers for VAW, causing significant physical injuries and mental health problems, including suicide. Health care providers reported that violence survivors often hide their experiences of violence and do not seek any kind of help. Women feared that violence would increase in frequency and intensity if their perpetrators found out that they had disclosed their experiences of violence to health care providers. Local stakeholders emphasized the importance of engaging community leaders and garnering support from both women and men in interventions designed to reduce VAW and its impacts on mental health. Conclusions: Participants reported that verbal and physical violence is often perceived as a normal part of women's lives. Women should be made aware of available support services and empowered and supported to increase access and uptake of these services. Additionally, more individual-based counselling sessions that encourage women to escape violence and its mental health consequences while maintaining privacy and confidentiality are recommended. [ABSTRACT FROM AUTHOR]

Background: In Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning. Method: The study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis. Results: The results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p < 0.001). The study findings showed no statistically significant difference in participants' scores based on demographic factors, including whether they worked in urban or rural areas. Conclusion and recommendation: Utilizing VP cases appears to significantly enhance the continuous professional development of nurses, fostering a deliberate learning process that enables them to reflect on how they manage cases and, in turn, refine their clinical reasoning skills. This study strongly recommends incorporating VP cases in the continuous professional development of nurses at the primary health level (health centers). This is especially pertinent in a context where nurses are required to perform diagnostic processes similar to those employed by physicians. [ABSTRACT FROM AUTHOR]

Background: Unsafe abortion is a serious reproductive health problem in developing countries including Ethiopia. The attitude of healthcare providers toward abortion is one of contributing factors to unsafe abortion. This study aimed to determine the pooled effect of healthcare workers' attitudes toward safe abortion care and its determinants factors in Ethiopia. Methods: Search engines such as Scopus, CINAHL, EMBASE, PubMed, Web of Science, and CAB Abstracts were used to find published studies where as Google and Google Scholar were used to find unpublished research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. The analysis was performed using STATA 14 and the random-effects model was used to calculate the odds ratios of medical professionals' attitudes regarding safe abortion services. Study heterogeneity was assessed by using I 2 and P -values. To evaluate the stability of pooled values to outliers and publication bias, respectively, sensitivity analysis and funnel plot were also performed. Results: A total of 15 published and unpublished articles with a sample size of 4060 were incorporated in this Review. The overall pooled prevalence of this study was 56% (95% CI: 45-67). Sex of participants (AOR: 2.37; 95% CI: 1.57, 3.58), having training (AOR: 2.86; 95% CI: 1.58, 5.17), Professional type (AOR: 1.55; 95% CI: 1.04, 4.46), and knowledge of abortion law (AOR:2.26; 95% CI: 1.14, 4.46) were the determinants factors that significantly associated with health care workers' attitude toward safe abortion care. Sensitivity analysis shows that the pooled odds ratios were consistently stable throughout all meta-analyses, and the funnel plot shows no evidence of publication bias. Conclusion: Half of health care providers sampled among the pooled studies have favorable attitudes toward abortion services in Ethiopia; which could hamper women's access to safe abortion care. Sex, training, type of profession, and knowing abortion law were determinants of health care workers' attitudes toward safe abortion services. Stakeholders should emphasize improving the attitude of healthcare workers toward safe abortion care which has a vital role in reducing maternal mortality. Moreover, working on modifiable factors like training, assigning personnel whose professions align with the service, and updating care providers about abortion law is also the essential key point to improve their intentions to deliver the services. [ABSTRACT FROM AUTHOR]

Background: Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. Methods: We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). Results: Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. Conclusion: Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health. [ABSTRACT FROM AUTHOR]

Children who experience sexual or physical abuse often delay their disclosure. This study aimed to clarify the barriers and facilitators to abuse disclosure in a sample of children and adolescents participating in a police interview regarding alleged abuse. Semi-structured interviews were conducted with 13 children (nine girls) who participated in a police interview regarding alleged abuse. They were asked about their abuse disclosure, their own and others' reactions to it, and the help and support they received from health service providers and other adults. Thematic analysis was used to identify themes, categories, and subthemes in the data. The key theme that emerged was the domino effect of disclosures, which occurred in three ways: unintentionally, delayed, or to professionals. Delays in, and reluctance to, disclose is explained in various ways. Four sub-categories emerged: ambivalence in personal and others' reactions, missed opportunities, reflection depending on age, and varied psychosocial support needs. Notably, disclosure delays did occur because children identified abusive acts as transgressions or did not considered the abuse significant. The present study reveals the significance of others' reactions to children's disclosures. The pattern showed supportive responses when children reported transgressions committed by adults, whereas peer abuse was met with mixed responses. Importantly, health care providers such as doctors and psychologists were not preferred confidants. In line with previous research, disclosure to friends or non-abusive family members was more common. The present findings underscore the difficulty with which children disclose abusive experiences, even in instances where it led to a police investigation. Child care practitioners need to be better equipped to meet a basic standard facilitating children to confide in others about abusive experiences. To increase the likelihood of keeping children in therapy after abuse, more active involvement of the child during clinical intervention seems important. [ABSTRACT FROM AUTHOR]

The introduction of injectable HIV pre-exposure prophylaxis (PrEP) has the potential to significantly change the biomedical HIV prevention landscape. However, effective implementation will require health care providers to adopt, prescribe, and administer injectable PrEP within clinical settings. This study qualitatively examined challenges and benefit of injectable PrEP implementation from the perspective of health care providers. From April to August 2022, we conducted 19 in-depth interviews with current PrEP-prescribing health care providers in New York State, including 3 physician assistants, 5 physicians, and 11 nurse practitioners. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to report semantic-level themes regarding injectable PrEP implementation. More than half of participants (61%) were aware of injectable PrEP; only 21% had experience prescribing it. Qualitative findings highlighted five themes. Three themes represented implementation challenges, including speculative concerns about side effects, appointment compliance, and practical and logistical considerations. The remaining two themes described benefits of injectable PrEP relative to oral PrEP, which included greater convenience and enhanced privacy. Findings from this qualitative study make significant applied contributions to the sparse knowledge on health care provider perspectives of injectable PrEP post-US Food and Drug Administration approval and their concerns and considerations regarding implementation in real-world clinical settings. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction: To achieve more equitable health, health care must be grounded in an understanding of social determinants of health. Clinicians need hands-on, equity-centered training in interdisciplinary settings where they can further develop leadership skills and apply learnings in real-time. The Clinical Scholars program trained five cohorts of health care professionals in 25 leadership development competencies to contribute toward advancing health equity within the organizations and communities where they work. This study describes the self-reported ratings of three dimensions of competencies within four domains. Methods: Data from 169 Fellows were collected at three time-points during the three-year training program using Qualtrics and Research Electronic Data Captrue software. Analysis was conducted in R and included descriptive statistics, fitting a linear mixed-effects model using random intercepts, and paired-sample t tests to assess significance between baseline and endpoint ratings. Results: We found improved ratings over time for each of the three competency dimensions (knowledge, self-efficacy, use) and significant differences in ratings from baseline to endpoint, by domain (personal, interpersonal, organizational, community, and systems). Discussion: These findings support the effectiveness of an equity-centered leadership development curriculum in training health care professionals to address health challenges in their communities and organizations, thereby furthering the broader goal of achieving more equitable health for all. [ABSTRACT FROM AUTHOR]

This article examines the role of individual, facility and system-level preparedness in reducing physiological and psychological vulnerability among primary-level health care providers (HCPs) during the COVID-19 pandemic in Rajasthan, India. Online and telephonic interviews are conducted among 274 HCPs working in 24 primary health centres (PHCs) (17 rural and 7 urban) across 13 districts of Rajasthan. Five dimensions of vulnerability, covering awareness, exposure to infection (daily contact; contact with high-risk individuals), physical and mental health conditions, while three aspects of preparedness—at individual (personal care) and facility (provider safety; management and supervision) level—are measured by employing factor analysis. Generalised ordered logit regression model is used to measure the effect of preparedness on COVID-19-related vulnerability. Among the 274 HCPs, majority of the staff are from rural PHCs (76%), less than 35 years old (87%), female (57%) and married (57%). Almost half have high level of exposure to COVID-19, with mean contact rate of 90. Overall, 26% have comprehensive knowledge of COVID-19, and 32% have any mental health issues. Although more than 70% of HCPs have reported more than one individual-level preparedness, mental health measures adopted by the HCPs are comparably low. The facility-level preparedness for enhancing safety is high such as social distancing (79%) and maintaining record of each visitor (75%). However, management-related measures adopted by the PHCs are perceived to be lower than the safety measures. The regression analyses suggest that safety-related preparedness is significantly associated with reduction of vulnerability by 50%. The management-level preparedness has statistically no significant effect in explaining the variations in level of vulnerability. The facility-level safety measures, which lower chances of acquiring infection, have a positive effect on reducing vulnerability to COVID-19. However, the HCPs do not have adequate preparedness at individual, facility management (PHC) and system levels to reduce COVID-19 vulnerability. Findings suggest that there is a need for a non-conventional approach of monitoring and supervision. In the absence of such measures, there is a chance of moral injury that will make the HCPs at the primary level vulnerable both physiologically and psychologically. [ABSTRACT FROM AUTHOR]

Abstract Background Tuberculosis (TB) preventive treatment (TPT) substantially reduces the risk of developing active TB for people living with HIV (PLHIV). We utilized a novel implementation strategy based on choice architecture (CAT) which makes TPT prescribing the default option. Through CAT, health care workers (HCWs) need to “opt-out” when choosing not to prescribe TPT to PLHIV. We assessed the prospective, concurrent, and retrospective acceptability of TPT prescribing among HCWs in Malawi who worked in clinics participating in a cluster randomized trial of the CAT intervention. Methods 28 in-depth semi-structured interviews were conducted with HCWs from control (standard prescribing approach) and intervention (CAT approach) clinics. The CAT approach was facilitated in intervention clinics using a default prescribing module built into the point-of-care HIV Electronic Medical Record (EMR) system. An interview guide for the qualitative CAT assessment was developed based on the theoretical framework of acceptability and on the normalization process theory. Thematic analysis was used to code the data, using NVivo 12 software. Results We identified eight themes belonging to the three chronological constructs of acceptability. HCWs expressed no tension for changing the standard approach to TPT prescribing (prospective acceptability); however, those exposed to CAT described several advantages, including that it served as a reminder to prescribe TPT and routinized TPT prescribing (concurrent acceptability). Some felt that CAT may reduce HCW´s autonomy and might lead to inappropriate TPT prescribing (retrospective acceptability). Conclusions The default prescribing module for TPT has now been incorporated into the point-of-care EMR system nationally in Malawi. This seems to fit the acceptability of the HCWs. Moving forward, it is important to train HCWs on how the EMR can be leveraged to determine who is eligible for TPT and who is not, while acknowledging the autonomy of HCWs.

Abstract Background The rapid advancement of technology has led to a concurrent advancement of telemedicine, that is the delivery of medical services over a long distance using technological methods. The consistently growing numbers of COVID-19 cases warranted the use of telemedicine as an alternative method of care-delivery. This study aims to evaluate perceptions of healthcare services provided virtually among healthcare providers (HCPs) in Kuwait and to assess their acceptance and intention to implement such services. Methods An exploratory mixed methods design was conducted, where in phase one HCPs’ perceptions towards telemedicine were explored through an online questionnaire and the quantitative data were summarized by descriptive analysis using SPSS. Scores for usefulness and for attitude toward the use of telemedicine were calculated. Then semi-structured interviews were conducted in phase two and the qualitative data were analyzed thematically. Results In phase one, 421 HCPs answered the questionnaire. In terms of telemedicine knowledge, 15.4% of HCPs had previously used telemedicine technology and 39% already knew about it. Additionally, 42.3% preferred to use telemedicine, and 88.5% had a moderate to high usefulness score. Telemedicine’s ease of use was perceived positively. Attitude median score was 73 with an IQR of 16 (63–79). Half of the participants intend to use telemedicine. In phase two, twenty-two interviews were conducted resulting in six themes; HCPs’ acceptance of telemedicine, facilitators and motives for telemedicine implementation, skills and training required to conduct telemedicine, barriers limiting the use of telemedicine, strategies to overcome the barriers, and benefits of telemedicine. Conclusion Most of the HCPs favor telemedicine integration into Kuwait’s healthcare system as their perceptions of telemedicine were overall positive, paving the way to develop implementation strategies.

Abstract Background Machine learning based clinical decision support systems (CDSSs) have been proposed as a means of advancing personalized treatment planning for disorders, such as depression, that have a multifaceted etiology, course, and symptom profile. However, machine learning based models for treatment selection are rare in the field of psychiatry. They have also not yet been translated for use in clinical practice. Understanding key stakeholder attitudes toward machine learning based CDSSs is critical for developing plans for their implementation that promote uptake by both providers and families. Methods In Study 1, a prototype machine learning based Clinical Decision Support System for Youth Depression (CDSS-YD) was demonstrated to focus groups of adolescents with a diagnosis of depression (n = 9), parents (n = 11), and behavioral health providers (n = 8). Qualitative analysis was used to assess their attitudes towards the CDSS-YD. In Study 2, behavioral health providers were trained in the use of the CDSS-YD and they utilized the CDSS-YD in a clinical encounter with 6 adolescents and their parents as part of their treatment planning discussion. Following the appointment, providers, parents, and adolescents completed a survey about their attitudes regarding the use of the CDSS-YD. Results All stakeholder groups viewed the CDSS-YD as an easy to understand and useful tool for making personalized treatment decisions, and families and providers were able to successfully use the CDSS-YD in clinical encounters. Parents and adolescents viewed their providers as having a critical role in the use the CDSS-YD, and this had implications for the perceived trustworthiness of the CDSS-YD. Providers reported that clinic productivity metrics would be the primary barrier to CDSS-YD implementation, with the creation of protected time for training, preparation, and use as a key facilitator. Conclusions Machine learning based CDSSs, if proven effective, have the potential to be widely accepted tools for personalized treatment planning. Successful implementation will require addressing the system-level barrier of having sufficient time and energy to integrate it into practice.

Background: The satisfaction of healthcare employees in their jobs is crucial due to its impact on the quality of services provided. Additionally, the presence of adequate job satisfaction is essential to avoid negative consequences in healthcare delivery, such as high turnover rates and low performance.Objectives: This study aimed to address the knowledge gap regarding the measurement of current job satisfaction levels among healthcare providers in both governmental and private hospitals in the West Bank.Methods: This research follows a cross-sectional design and utilizes a quantitative approach. Data were collected from a total of 370 employees working in the healthcare sector, including both private and public hospitals. To assess job satisfaction, the researchers employed a self-administered Mueller/McCloskey satisfaction scale, which was based on previous studies conducted by Clinton in 2015. This scale was administered to employees across various departments and specialties.Results: In various aspects, healthcare providers express a satisfaction level of over 30%. These aspects include their monthly salary, annual leave and holidays, working hours, weekend arrangements, interactions with supervisors and colleagues, social communication during work hours, collaboration with healthcare professionals from different specialties, work environment, and working conditions. The results indicate that a majority of healthcare providers (54.9%) are generally content, scoring between 60% and less than 80%. Conversely, approximately one-third of them (33.6%) express general dissatisfaction, scoring below 60%.Conclusion: More than half of the healthcare providers in both governmental and private hospitals in the West Bank expressed a general sense of satisfaction. Married and older healthcare providers are more satisfied with their jobs compared to younger and single employees.

Abstract Background Adolescents in low-middle-income countries often face limited access to health information and services due to several different factors. Ineffective communication between healthcare providers and adolescents is among them. This study aims to assess adolescents’ perspectives regarding their communication with reproductive health service providers in Rwanda. Methods A phenomenological exploratory qualitative study was used. Eleven focus group discussions were conducted among adolescents aged 10 to 19 years between December 2020 and January 2021. All participants were identified through their respective health care providers in youth-friendly centres available in the Kigali district representing the urban area and Kamonyi district representing the rural area. All interviews were transcribed and translated into English and analysed by using thematic content analysis. Results Poor communication between healthcare providers and adolescents was identified and attributed to the judgmental attitudes of some healthcare providers, while good communication was cited by many adolescents as an important key of access to services. All adolescents were eager to access reproductive health services and be educated about reproductive health issues. Conclusion Effective communication is essential when it comes to providing reproductive health services, as this establishes a strong relationship between a service provider and an adolescent who wants to talk about their concerns, while poor communication prevents adolescents from asking questions about unknown topics.

Background A monkeypox (MPOX) outbreak occurred in May 2022. On June 3, 2022, the WHO Blueprint organized a consultation on MPOX research knowledge gaps and priority research questions because the engagement of health care providers (HCPs) in providing accurate information and the public's motivation to adapt protective behaviour were crucial. Thus, we conducted this study to explore the knowledge issues, animal patterns, and interactions of HCPs in the context of MPOX and COVID-19 during the MPOX outbreak.Methods We conducted a cross-sectional web-based survey among 816 HCPs working in governmental health facilities from many countries, mainly Syria, Egypt, Saudi Arabia, and Cameroon, in September 2022.Results Four hundred and sixty (56.37%) were aged between 18 and less than 35 years old. About 34.44% were physicians, while only 37.25% worked on the frontlines with patients. 37.99% and 5.88% received vaccinations against chickenpox and MPOX, respectively. In the meantime, 55.39% had taken courses or training programmes regarding COVID-19. Regarding knowledge-seeking behaviours (KSBs) about COVID-19, 38.73% were through passive attention, while only 28.8% got their information through active search. Most of the participants (56.86%) had a moderate level of knowledge regarding COVID-19. Only 8.82% had courses or training programmes regarding MPOX. Regarding KSB about MPOX, 50.86% were obtained through passive attention, while only 18.01% and 23.04% got their information through active and passive search, respectively. Most of the participants (57.60%) had a poor level of knowledge regarding MPOX. The regression analysis of the MPOX knowledge score revealed that individuals working on the frontlines with patients and those who had training programmes or courses were shown to have a higher score by 1.25 and 3.18 points, respectively.Conclusions The studied HCPs had poorer knowledge about the MPOX virus than they did about the SARS-CoV-2 virus. Training programmes and education courses had an impact on their knowledge.

Purpose For children with neurodevelopmental disabilities (CWNDs), early diagnosis that leads to early intervention with regular targeted therapies is critical. In Qatar, private therapy centres that address this demand often have highly exclusive prices restricting families from availing them. This paper examines the challenges faced by families with CWNDs, as well as various financial and systemic obstacles, from the vantage point of these centres, all of which culminate in an extraordinarily high disability price tag for disability families in Qatar. Methods This study is based on qualitative, semi-structured, and in-depth interviews with private therapy centres and developmental paediatricians. Results Therapy centre representatives expressed common struggles in lengthy and cumbersome administration and licencing procedures, difficulty in hiring and retaining high quality staff, and expenses that need to be paid to the state. From their experience, families largely struggle with delayed diagnoses that significantly slow down intervention plans and therapies as well as staggeringly high financial costs with a dearth of funding options. Conclusions We recommend sincere engagement, dialogue, and cooperation between multiple stakeholders; a supportive ecosystem to balance and distribute the demand that includes schools and parents; as well more efficient administrative procedures and recruitment strategies.

Purpose: This study examines providers’ and clinic staff’s perspectives on patient-reported outcomes (PROs) implementation at an academic medical center. Methods: An anonymous and voluntary survey was administered to Henry Ford Cancer providers and clinic staff 18 months after PROs program implementation in September 2020, to obtain their feedback on perceived barriers, impact on workflows, and PROs administration frequency in routine cancer care. Results: A total of 180 providers and 40 clinic staff were invited to complete the survey; 31% and 63% completed the survey, respectively. Approximately 68% of providers reported that electronically integrated PROs scores were either beneficial or somewhat beneficial to their patients, while only 28% of the clinic staff reported that PROs were beneficial or somewhat beneficial to patients. According to the clinic staff, the most common barriers to PROs completion included lack of patients’ awareness of the utility of the program with respect to their care, patients’ health status at check-in, and PROs being offered too frequently. Conclusion: There is favorable acceptance of the PROs program by providers, but clinic staff found it less favorable. Interventions to address barriers and improve program engagement are needed to ensure broad adoption of PROs in oncology practice. [ABSTRACT FROM AUTHOR]

Context: As per the national policy, two doses of COVID‑19 vaccine at least four weeks apart were available for administration to all HCW’s since January 2021. A small proportion of individuals will contract COVID‑19 despite complete vaccination. Healthcare workers (Health Care Providers) represent a very high‑risk group for contracting COVID‑19 infection. Aim: To determine the breakthrough infection rate of COVID‑19 among vaccinated healthcare providers and students. Methodology: The present cross‑sectional study was conducted at All India Institute of Medical Sciences, Nagpur from August to December 2022. The sample size of 308 was achieved through proportionate stratified sampling among different cadres of employees working at the institute. Statistical Analysis: Chi‑square test was used for significance. Fischer’s Exact test was used wherever necessary. A P value < 0.05 was considered statistically significant. Strength of the association was estimated using odds ratio. Results: The mean (SD) age of participants in our study was 29.26 (±8.64) years. Prevalence of COVID breakthrough infection was found to be 28.25% [95% CI: 23–33]. It was found that those participants having one or more co‑morbidities and are directly involved in COVID patient care were likely to suffer more from COVID‑19 breakthrough infection. Conclusion: Predictors of COVID‑19 breakthrough infection found to be a presence of one or more co‑morbidities, direct involvement with COVID‑19 patients and not observing respiratory hygiene. There is increased risk among participants with comorbidities and involving directly in patient care. Therefore, it is recommended that vaccine policy needs to focus on high‑risk group. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) preventive treatment (TPT) substantially reduces the risk of developing active TB for people living with HIV (PLHIV). We utilized a novel implementation strategy based on choice architecture (CAT) which makes TPT prescribing the default option. Through CAT, health care workers (HCWs) need to "opt-out" when choosing not to prescribe TPT to PLHIV. We assessed the prospective, concurrent, and retrospective acceptability of TPT prescribing among HCWs in Malawi who worked in clinics participating in a cluster randomized trial of the CAT intervention. Methods: 28 in-depth semi-structured interviews were conducted with HCWs from control (standard prescribing approach) and intervention (CAT approach) clinics. The CAT approach was facilitated in intervention clinics using a default prescribing module built into the point-of-care HIV Electronic Medical Record (EMR) system. An interview guide for the qualitative CAT assessment was developed based on the theoretical framework of acceptability and on the normalization process theory. Thematic analysis was used to code the data, using NVivo 12 software. Results: We identified eight themes belonging to the three chronological constructs of acceptability. HCWs expressed no tension for changing the standard approach to TPT prescribing (prospective acceptability); however, those exposed to CAT described several advantages, including that it served as a reminder to prescribe TPT and routinized TPT prescribing (concurrent acceptability). Some felt that CAT may reduce HCW´s autonomy and might lead to inappropriate TPT prescribing (retrospective acceptability). Conclusions: The default prescribing module for TPT has now been incorporated into the point-of-care EMR system nationally in Malawi. This seems to fit the acceptability of the HCWs. Moving forward, it is important to train HCWs on how the EMR can be leveraged to determine who is eligible for TPT and who is not, while acknowledging the autonomy of HCWs. [ABSTRACT FROM AUTHOR]

Introduction: With wider adoption of store-and-forward telemedicine accelerating, particularly post-coronavirus disease 2019, it is essential to understand health care providers' (HCPs) satisfaction with digital solutions offered by telemedicine organizations to (continuously) guarantee service quality. We developed the Store-and-Forward Telemedicine Service User-satisfaction Questionnaire to monitor and assess HCPs' experiences with contracted telemedicine organizations. Methods: Questionnaire construction (phase 1) consisted of exploratory literature search on validated telemedicine satisfaction questionnaires, a telemedicine domain and human factors expert focus group, stakeholder focus group (customer service employee and telemedicine account managers), and two pre-testing rounds among 18 HCPs. The pilot questionnaire (phase 2) was sent to 2179 HCPs for validity and reliability assessment. Results: Phase 1: Two validated questionnaires (73 items overall) were used as input for Store-and-Forward Telemedicine Service User-satisfaction Questionnaire. Revisions resulted in 61 items. Phase 2: the pilot 61-item Store-and-Forward Telemedicine Service User-satisfaction Questionnaire instrument was completed by 181 of 2179 invited HCPs. Forty-one mandatory items of the pilot Store-and-Forward Telemedicine Service User-satisfaction Questionnaire rated on a 5-point Likert scale were included in psychometric analyses and resulted in six reliable scales: training, communication, organization policy and strategy, interaction platform, usage platform, and working conditions. Discussion: The Store-and-Forward Telemedicine Service User-satisfaction Questionnaire is a reliable and valid questionnaire for measuring HCPs' satisfaction with store-and-forward telemedicine services as part of a continuous quality improvement cycle. Reimbursement questions were excluded due to low response. As adoption of telemedicine may be impeded by financial compensation issues, this requires consideration in future telemedicine questionnaires. Store-and-Forward Telemedicine Service User-satisfaction Questionnaire including video consultation items is needed to monitor also synchronous services as these expanded in the coronavirus disease 2019 pandemic. [ABSTRACT FROM AUTHOR]

Background: Machine learning based clinical decision support systems (CDSSs) have been proposed as a means of advancing personalized treatment planning for disorders, such as depression, that have a multifaceted etiology, course, and symptom profile. However, machine learning based models for treatment selection are rare in the field of psychiatry. They have also not yet been translated for use in clinical practice. Understanding key stakeholder attitudes toward machine learning based CDSSs is critical for developing plans for their implementation that promote uptake by both providers and families. Methods: In Study 1, a prototype machine learning based Clinical Decision Support System for Youth Depression (CDSS-YD) was demonstrated to focus groups of adolescents with a diagnosis of depression (n = 9), parents (n = 11), and behavioral health providers (n = 8). Qualitative analysis was used to assess their attitudes towards the CDSS-YD. In Study 2, behavioral health providers were trained in the use of the CDSS-YD and they utilized the CDSS-YD in a clinical encounter with 6 adolescents and their parents as part of their treatment planning discussion. Following the appointment, providers, parents, and adolescents completed a survey about their attitudes regarding the use of the CDSS-YD. Results: All stakeholder groups viewed the CDSS-YD as an easy to understand and useful tool for making personalized treatment decisions, and families and providers were able to successfully use the CDSS-YD in clinical encounters. Parents and adolescents viewed their providers as having a critical role in the use the CDSS-YD, and this had implications for the perceived trustworthiness of the CDSS-YD. Providers reported that clinic productivity metrics would be the primary barrier to CDSS-YD implementation, with the creation of protected time for training, preparation, and use as a key facilitator. Conclusions: Machine learning based CDSSs, if proven effective, have the potential to be widely accepted tools for personalized treatment planning. Successful implementation will require addressing the system-level barrier of having sufficient time and energy to integrate it into practice. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction: Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies. Method: A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results. Results: The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement. Discussion: Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication. [ABSTRACT FROM AUTHOR]

Background: The rapid advancement of technology has led to a concurrent advancement of telemedicine, that is the delivery of medical services over a long distance using technological methods. The consistently growing numbers of COVID-19 cases warranted the use of telemedicine as an alternative method of care-delivery. This study aims to evaluate perceptions of healthcare services provided virtually among healthcare providers (HCPs) in Kuwait and to assess their acceptance and intention to implement such services. Methods: An exploratory mixed methods design was conducted, where in phase one HCPs' perceptions towards telemedicine were explored through an online questionnaire and the quantitative data were summarized by descriptive analysis using SPSS. Scores for usefulness and for attitude toward the use of telemedicine were calculated. Then semi-structured interviews were conducted in phase two and the qualitative data were analyzed thematically. Results: In phase one, 421 HCPs answered the questionnaire. In terms of telemedicine knowledge, 15.4% of HCPs had previously used telemedicine technology and 39% already knew about it. Additionally, 42.3% preferred to use telemedicine, and 88.5% had a moderate to high usefulness score. Telemedicine's ease of use was perceived positively. Attitude median score was 73 with an IQR of 16 (63–79). Half of the participants intend to use telemedicine. In phase two, twenty-two interviews were conducted resulting in six themes; HCPs' acceptance of telemedicine, facilitators and motives for telemedicine implementation, skills and training required to conduct telemedicine, barriers limiting the use of telemedicine, strategies to overcome the barriers, and benefits of telemedicine. Conclusion: Most of the HCPs favor telemedicine integration into Kuwait's healthcare system as their perceptions of telemedicine were overall positive, paving the way to develop implementation strategies. [ABSTRACT FROM AUTHOR]

Introduction: Women often experience breastfeeding difficulties leading to premature supplementation and cessation. Implementing evidence-informed eHealth resources in clinical interactions with health care providers (HCPs), both in the health department and hospitals throughout a health region may help address this longstanding clinical issue. However, the provision of an eHealth resource alone is not sufficient to increase breastfeeding rates and health literacy, as the effective implementation of the eHealth resource in clinical practice is required. As such, our study objective was to conduct a needs assessment with HCPs to determine the barriers, facilitators, and perceived acceptability of the eHealth resource. Methods: A non-experimental descriptive study was used to examine HCPs' perceptions of barriers and facilitators to the implementation of an eHealth resource in clinical settings. HCPs completed an online questionnaire to determine barriers and facilitators informed by the Consolidated Framework for Implementation Research (CFIR). Results: HCPs (n=44) completed the survey and agreed the resource was credible (86%), up to date (84%), covered relevant topics (91%), would ease their ability to provide breastfeeding education (82%), and would increase consistent messaging (86%). They agreed it would increase parents' breastfeeding health literacy (91%) and help parents meet their breastfeeding goals (86%). Concerns were expressed regarding how this would be used in clinical interactions due to challenges with navigation, searchability, and the large amount of content. Implications and Conclusion: HCPs rated the eHealth resource highly; however, adaptations to the local context are required. For effective implementation of interventions in clinical settings, HCPs' perceptions should be explored to determine their specific needs and determine how to best adapt the intervention to their setting to increase acceptability and facilitate use in clinical interactions. [ABSTRACT FROM AUTHOR]

Background: Drug hypersensitivity reactions (DHRs) are immune-mediated responses triggered by exposure to a drug. DHRs are responsible for serious adverse drug reactions (ADRs) and are considered the fifth leading cause of death. This study aims to assess and evaluate the knowledge, practice, and attitudes of healthcare providers (HCPs) towards DHRs. Methods: A cross-sectional survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Healthcare providers, including pharmacists, physicians, and nurses, were recruited using a convenience sampling method to complete the survey. The survey comprised three domains: knowledge (14 items), attitudes (5 items), and practices (6 items), utilizing a standardized self-administered questionnaire. Results: The survey was completed by 373 healthcare providers. The respondents were predominantly female (72.1 %) with a mean age of 33.8 ± 7.8 years. Of the respondents, 64 % were nurses, 25 % pharmacists, and 11.3 % physicians. Educational levels varied, with 53 % holding a bachelor's degree, 22 % an associate degree, and 25 % a master's degree or higher. The median knowledge score was 48. Female healthcare providers, those with advanced levels of education, and physicians had higher knowledge scores compared to male and nurse participants (p

Abstract Background Outreach efforts were developed to bolster people’s access to and use of immunization services in underserved populations. However, there have been multiple outbreaks of diseases like measles in Uganda, prompting policy makers and stakeholders to ask many unanswered questions. This research study was created to uncover the discrepancies between vaccine management practices at immunization outreach sessions in rural South Western Uganda compared with existing standards. Methods The observational qualitative study, was done in 16 public health facilities across four districts of Uganda. Data were collected using in-depth interviews, facility record reviews, and observation. We assessed the vaccine management procedures before immunization session, transportation used, set up at the outreach site, management practices during the outreach session and packing of vaccines - according to World Health Organization immunization practice recommendations. The data were transcribed, coded and categories were formed and triangulated. Themes were generated based on a socio-ecologic framework to gain a better understanding of healthcare provider practices during immunization sessions. Results Fifty-one individuals were interviewed; four Assistant District Health Officers, four cold chain technicians, 15 focal persons for the Expanded Program on Immunization, and 28 health care providers. The respondents’ mean age was 35, 43 (84.3%) were females and 24 (47.1%) had a diploma. 11 (69%) outreaches were conducted at a distance of 5-12 km from the health facility and 7 (44%) were conducted in a building. For 8 outreaches (50%) health facility staff did not check the vaccine vial monitor status before the outreach while 12(75%) did not keep the vaccine hard lid cover closed during the sessions. The main areas of concern were insufficient vaccine integrity monitoring, improper handling and storage practices, deficient documentation, and inadequate vaccine transportation. These were similar across immunization outreach sites regardless of vaccine preventable disease outbreaks occurrences. The majority of these gaps were located at the individual level but were enabled by policy/environmental factors. Conclusions There are poor vaccine management procedures during outreach sessions contrary to established guidelines. Specific tactics to tackle knowledge deficiencies, health worker attitude, and fewer equipment shortages could improve compliance to guidelines.

Abstract Background Suicide cases in Palestine continue to record a remarkable annual increase, but we lack a comprehensive verified national data collection system of suicide and it is expected that real numbers of attempted/suicide in Palestine are higher because not all suicide or attempted suicide cases are reported. The purpose of this study was to test the effectiveness of a time-limited training intervention in enhancing healthcare providers’ diagnostic and intervention skills to deal with suicidal patients who visit emergency departments in Palestinian hospitals. Methods The sample consisted of 43 healthcare providers who work in public hospitals in the northern of the West Bank of Palestine, ranging from 25 to 56 years, involving 36 males and 7 females. A one-group quasi-experimental design was used, in which the experimental group received a training program to enhance healthcare providers’ diagnostic and intervention skills to deal with suicidal ideations and attempts, the intervention lasted for 8 weeks, with 1 session per week. The performance of the experimental group was tested before and after the intervention. Results Our findings revealed the effectiveness of the training intervention in enhancing participants’ suicide assessment, diagnosis, and self-care skills. Conclusions These results suggest that a brief and carefully developed training intervention can potentially change healthcare providers’ perceptions and behaviors toward suicide with a possible impact on clinical care therein.

Simulated standardized patients (SSP) have emerged as close to a gold standard for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with real patients in a given health system? Here, we reject the proposition that SSPs are direct substitutes for real patients and that the validity of SSP studies therefore relies on their ability to imitate real patients. Instead, we argue that the success of the SSP methodology lies in its counterfactual manipulations of the possibilities available to real careseekers - especially those paths not taken up by them - through which real responses can be elicited from real providers. Using results from a unique pilot study where SSPs returned to providers for follow-ups when asked, we demonstrate that the SSP method works well to elicit responses from the provider through conditional manipulations of SSP behavior. At the same time, observational methods are better suited to understand what choices real people make, and how these can affect the direction of diagnosis and treatment. A combination of SSP and observational methods can thus help parse out how quality of care emerges for the patient as a shared history between care-seeking individuals and care providers.